What to do if a problem develops


The following are some problems that can develop after surgery. Speak with your bariatric team for help regarding these issues. 

Anorexia

In some cases, rapid weight loss can trigger previous eating disorders and some people who binge-ate before surgery may lean towards anorexia after surgery. This happens to a very small number of people but it is a serious concern. Getting help is not a weakness, it’s a sign of strength. Speak with your surgeon, nurse, or dietitian regarding this and ask for a referral to a psychologist for help.

Constipation

Because of the pre-operative diet and the low fibre diet in the first 5 weeks after surgery, most people will experience constipation. It is important to drink enough water to prevent dehydration and constipation by taking very frequent small sips. In the long term, increase intake of fibre-rich foods such as bran, fresh fruits and vegetables, prunes, and whole grain breads and cereals. Get plenty of exercise. Our dietitian can help you find ways to increase fibre in your diet and may recommend some fibre supplements.

Dehydration

The symptoms of dehydration are: dark yellow, strong smelling urine; a small amount of urine; dry skin and mouth; feeling tired and unwell. Try to drink a total of 1.5 to 2 litres of water per day. Sip water continuously until your urine becomes a normal colour. This should already improve within 24 hours. If you are unable to drink enough liquid to keep hydrated, speak with our nurse.

Depression / Mood changes / Irritability

A healthy lifestyle is important for mental health, which includes eating well, taking your prescribed vitamins and minerals, exercising, and sleeping well. However, bariatric surgery does not ‘fix’ all of our problems. For some, eating may have been a way to cope with these feelings, but this is no longer possible after surgery.  This is why it’s important to consult with a psychologist to work through the feelings you may have, whether these feelings continue from before your surgery, or if they are new feelings that develop after surgery. Ask our surgeon or nurse for a referral. We also encourage to join a bariatric support group (several options online) as you will feel less alone on your bariatric journey.

Dumping syndrome

Dumping syndrome occurs after eating food that is high in sugar, most commonly after a gastric bypass, but can also occur occasionally after a sleeve gastrectomy. The most common symptoms are abdominal cramps, heart palpitations, nausea, diarrhea, and sweating. This discourages patients from eating these types of foods and promotes additional weight loss. Avoid eating sweets or concentrated sugars and avoid drinking while eating. Speak with our dietitian to learn more about preventing dumping syndrome and how to enjoy the very occasional sweet treat.

Frequent bowel movements (diarrhea)

Your diet may be causing frequent bowel movements or diarrhea. Limit the amount of sweet foods and high fat foods that you eat. In some cases, diarrhea may be caused by other more concerning medical issues or certain medications. Contact our nurse if you are experiencing this problem despite making changes to your diet.

Gas and bloating

It’s possible to become more sensitive to milk after surgery and develop lactose intolerance. You may choose to try lactose-free milk to see if your symptoms improve. This intolerance to lactose may be temporary and you could slowly introduce small quantities of regular milk. Discuss any intolerance of milk or milk products with our dietitian.

Hair loss

The hair loss usually occurs anywhere from 3 to 6 months after surgery. Take your multivitamins regularly and consume the daily amount of protein recommended by our dietitian and learn about good sources of protein.  If hair loss persists, discuss this with the bariatric surgeon, nurse, or dietitian. Ask the dietitian for more information about the protein powder supplements, if necessary.

Heartburn (burning feeling in stomach)

Heartburn may be the cause of food intolerance and vomiting. Avoid coffee, tea, soft drinks, alcohol, chocolate, black and red pepper, spicy foods or any other foods that may cause burning. If you are smoking, you must stop immediately. Discuss these symptoms with our nurse for more help.

Headaches

Use Tylenol, Atasol or any other non aspirin product for pains and headaches. Non steroidal anti-inflammatory drugs (NSAIDs) such as Motrin (ibuprofen), Indocid, Celebrex, Naprosyn, Aspirin, Novo-defenac, etc., are not recommended because they can cause irritation and ulcers at the exit of your small gastric pouch. Consult your family practitioner or pharmacist for alternative options to these medications.

Hunger / Strong desire to eat more than usual

Stop eating as soon as you feel full even if you have not finished all the food you were intending to eat. Measure your portions of food and eat only that quantity. Try to recognize if old habits related to compulsive eating or grazing/nibbling are creeping up on you again. It’s important to eat meals regularly and focus on having enough protein. Discuss this with our dietitian if you’re unsure if you’re meeting your protein needs. Women may feel hungrier before their menstrual period begins. Compare your desire to eat with your menstrual cycle to help you spot the difference between a normal increase in hunger and the return of your old hunger sensations. If you need help managing the desire to eat or help to understand the difference between hunger and appetite, discuss this with the dietitian and discuss how a psychologist may be able to help you with this.

Inability to eat like everyone else

Remember how the surgery works. You can no longer eat like everyone else because your operation will restrict the type and amount of food that you might be used to eating. Remember that it is possible to stretch your new “stomach” and this can affect your weight loss and long-term weight maintenance. This could happen when you eat larger quantities than the amount of food that fits comfortably into your new small “stomach”. If you are having difficulty coping with smaller portions discuss this with our team to learn more about how working with a psychologist may be helpful.

Inability to keep down foods or liquids

Do not eat more than your stomach can hold and be sure to chew your food slowly. Some foods may not digest as well anymore such as doughy breads and fibrous vegetables. If medications and vitamins are larger than the size of a regular aspirin and you vomit after taking pills, discuss other options with your pharmacist (DO NOT crush your own medication unless a pharmacist says it is safe to do so). If you cannot eat any food, at least try to sip some water, bouillon,  or any other liquid so you don’t become dehydrated. Immediately call our nurse if you are unable to eat or drink despite all efforts after your surgery. If you vomit bright red blood, quickly go to the Emergency Room of the Montreal General Hospital or to your nearest hospital.

Inability to lose weight

If you recognize that your diet can be improved, discuss this with our dietitian for a tailored approach to working on this. If you are abkle to eat much larger portions than you expected, first discuss this with our dietitian who may evaluate if your portions appear normal after surgery. In some cases it’s possible that a lack of motivation (rather than a lack of knowledge) is the root cause of certain habits. Discuss this with our dietitian or nurse and ask about how a psychologist may be able to help you. We encourage joining a bariatric support group so that you may speak to others who have been in similar situations following their surgery.  If the nurse and/or dietitian determine that you have been unable to lose weight for reasons other than diet and exercise and following our recommendations, they may refer you back to our surgeon for an assessment.

Leg cramps

Eat a well-balanced diet and take your vitamins daily. Do not sit in the same position for a long time. About every half hour, stand up and move around a little. Do not cross your legs. Do not use “knee-highs” or socks with a tight band on them. If your legs become swollen, lie down on a sofa or a bed and elevate your legs above your heart.

Lightheadedness

If you feel dizzy or shaky, quickly eat a few soda crackers. Do not eat candy or chocolate. Eat a protein and starch snack, such as some cheese and crackers or greek yogurt and a fruit. Chew it well. This problem develops when there is a long time between meals or when you have skipped a meal. It is very important to eat your regular meals daily. Avoid alcohol.

Monotony of the diet

Keep a positive attitude. Concentrate on making the weight loss a success! Work with our dietitian to learn more about other food options that may work for you. Talk to others who have successfully lost weight. What did they do when they were discouraged? Joining a bariatric support group may be helpful.

Nausea / Heaviness in chest after eating

Only eat until you feel full or satiated. Nibble on dry soda crackers and be sure to keep hydrated by taking small sips of liquids. When you feel better, take some chicken noodle soup, soda crackers and warm tea. If the problem continues, please call the bariatric surgery team.

Stomach bloating after eating

Eat only up to the point of feeling full. Try to drink only between meals. Test small amounts of new foods at a time. If you become uncomfortable, cut back on the new foods that caused you the problem and proceed more cautiously. Exercise regularly, including walking; this will help to eliminate any gas that may be building up. If this happens after each time you eat, discuss this with our nurse or dietitian.

Tired or weak

It’s important to eat well after surgery which includes making sure you have enough protein, balanced with some carbs or whole grains.  Take your vitamins and minerals every day that are prescribed to you in order to prevent some deficiencies such as anemia. Particularly in the first few weeks after surgery, be realistic about what you can do in a day; your body is still healing and your nutrition is still suboptimal. Allow your body the time it needs to recover fully. If you persistently feel tired and weak, even 5 weeks from your surgery, discuss this with our nurse.

Wound infection

If you notice that a part of your incision is painful, red, and hot to touch, you may have a wound infection. Contact Dr. Chow’s office.